Causes of infertility

Tubal problems

Tubal damage is a common cause of infertility. Damage
to the fimbriae may reduce or stop their ability to pick up the egg and
direct it into the Fallopian tube. Adhesions around the tube may distort
the tube or reduce their mobility, thus affecting their ability to pick
up the egg. Damage to the cells lining the tube may prevent sperm from
reaching the egg or greatly reduce the chance of fertilization. Blockage
of the tube can prevent the sperm from reaching the egg, or the fertilized
egg from moving to the uterus and increases the incidence of ectopic
pregnancy. Tubal blockage can be either proximal or distal. The former
is where the blockage is located close to the uterus, while the latter
is where it lies at the fimbriae.

Most women will not be aware of the tubal damage until
they have been investigated
for infertility. However, some may have severe period pains, irregular
or heavy periods, chronic or recurrent pelvic pain and tenderness.

Incidence

15-25%

What are the causes of tubal damage?

Infection

This is the commonest cause of tubal damage. Especially
if the infection goes untreated or is treated inadequately at the time
e.g.

Previous pelvic infection.

Sexually transmitted diseases such as chlamydia and gonorrhoea.

Wearing a coil (IUCD) can lead to infection in the womb, which
can spread to the tubes.

Spread of infection from internal organs such as appendicitis,
bowel infection.

After an abortion, miscarriage or delivery, an infection may spread
to the tubes.

Laparoscopy showing hydrosalpinx

Laparoscopy showing pelvic adhesions

Laparoscopy showing perihepatic adhesions

Surgery

Any surgery that involves the Fallopian tubes, ovaries
and uterus can cause adhesions. Sometimes abdominal surgery can also
result in adhesions that may affect the tube.Adhesions are bands of scar tissues that binds together organs and tissues. Adhesions are not only caused by surgery but it also caused by inflammation. Most adhesions cause no symptoms or problems but sometimes can cause chronic pelvic or abdominal pain and may cause bowel obstruction. Adhesiolysis is a surgical procedure to free organs, bowels or Fallopian tubes from the scar tissues and can be performed via a key hole surgery (laparoscopy) or through a cut in the abdominal (laparotomy). The outcome of adhesiolysis is usually favourable though adhesions often return.

Previous ectopic pregnancy

Previous ectopic pregnancies can be a cause of tubal
damage.

Congenital abnormality

This is an abnormal development before birth such
as an absent or maldeveloped tube.

Endometriosis

The condition endometriosis
can lead to scarring of the tubes, adhesions, and in severe cases to blockage
of the tubes.

Hydrosalpinx

Hydrosalpinx is a blocked, dilated, fluid filled Fallopian
tube usually caused by a previous pelvic infection. In mild cases fertility
may be restored by opening the tube surgically, otherwise IVF is the
treatment of choice. There is some evidence that hydrosalpinx reduces
the success rate of IVF and increases the risk of mscarriage. For this
reason, some doctors may advise removing, or occluding the hydrosalpinx
before the IVF treatment.